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Avanzar en el diagnóstico de la tuberculosis extrapulmonar: el potencial de la prueba de detección de antígenos

Ahmad Wali^1,2, Nauman Safdar³, Atiqa Ambreen⁴

¹Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Arstadveien 21, 5009 Bergen, Norway.

Pathogens (Basel, Switzerland)

|August 28, 2025

Resumen

La prueba de antígeno MPT64 es prometedora para el diagnóstico de la tuberculosis extrapulmonar (EPTB), especialmente la linfadenitis tuberculosa. Ofrece una mayor sensibilidad que Xpert MTB/RIF, ayudando al diagnóstico rápido en entornos de alta TB.

Área de la Ciencia:

Microbiología
Enfermedades infecciosas
Medicina de diagnóstico

Sus antecedentes:

El diagnóstico de la tuberculosis extrapulmonar (EPTB) es un desafío debido a su naturaleza paucibacillary y presentaciones variadas.
Los métodos convencionales como Xpert y el cultivo tienen limitaciones en el diagnóstico de EPTB, incluidas las dificultades de muestreo, la baja sensibilidad y los largos tiempos de respuesta.

Objetivo del estudio:

Evaluar el rendimiento de la prueba de detección de antígenos MPT64 para el diagnóstico de EPTB.
Evaluar específicamente su utilidad en la linfadenitis tuberculosa (TBLN) y la pleuritis tuberculosa (TBP) en un entorno de alta tuberculosis y baja incidencia de VIH.

Principales métodos:

Evaluación prospectiva de la prueba MPT64 con respecto al cultivo, la histopatología y la prueba Xpert MTB/RIF.
Las muestras incluyeron biopsias de ganglios linfáticos y bloqueos celulares de fluido pleural de pacientes con sospecha de EPTB.
Estudio realizado en Lahore, Pakistán, una zona de alta incidencia de la tuberculosis.

Principales resultados:

De 338 pacientes, 318 (94%) fueron diagnosticados con EPTB.
Para TBLN, la sensibilidad de MPT64 fue del 84% (frente al 48% de Xpert).
Para TBP, la sensibilidad de MPT64 fue del 51% (frente al 7% de Xpert).
En el TBLN confirmado por histopatología, el MPT64 (85%) superó al cultivo (58%) y al Xpert (47%).
La evaluación de la especificidad fue limitada debido al bajo número de casos no relacionados con la tuberculosis.

Conclusiones:

La prueba de antígeno MPT64 es una herramienta rápida y sensible prometedora para el diagnóstico de EPTB, particularmente TBLN, en entornos clínicos de rutina.
MPT64 demuestra una sensibilidad superior en comparación con Xpert MTB/RIF para estas condiciones.
Se necesita más investigación para confirmar la especificidad y explorar aplicaciones de diagnóstico más amplias.

Palabras clave:

Pakistán Inmunocitoquímica Inmunohistoquímica Enfermedad de las piernas Enfermedad de las articulaciones

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